Check Eligibility/Enrollment & Claim Status

All Forms are Copyrighted

Intervention Forms

• Manual Notes
• EZ Fill-in Notes
• Social Services
• Detox Transfer
• S/A   D/C   Home

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Billing Forms

• Assignment of Benefits and Authorization to Request, Obtain, Use and Release formation

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Arizona Petition Forms

• Addendum A
• Addendum B

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Client Forms

• Request for Inspection of Client Records
• Authorize for CMH to Release Info
• Consent to Release and Receive Info
• RBHA Referral Form

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Handouts

• Terms of Service Agreement
• Client Intake Adult
• DHS Consumer Rights
• DHS Consumer Rights SMI
• Spanish Patient Rights File
• Confidentiality Handout
• PCT Control System Compass LLC
• Refund Policy and Complaint Procedure